ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

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What is the mechanism of action of vancomycin?

Vancomycin inhibits bacterial cell wall synthesis by binding to the D-alanyl - D-alanine cell wall precursor and blocking peptidoglycan polymerization.

Which type of bacteria does vancomycin cover?

Vancomycin only covers Gram-positive bacteria, including Staphylococci (MRSA), Streptococci, Enterococci (not VRE) and C. difficile.

What is the dosing recommendation for systemic infections?

For systemic infections, the recommended IV dosing of vancomycin is 15-20 mg/kg Q8-12H, with the dose based on total body weight.

What are the side effects of vancomycin?

Abdominal pain, nausea, phlebitis, myelosuppression, drug fever, severe skin reactions Signup and view all the answers

What are the monitoring parameters for vancomycin therapy?

Renal function, trough serum concentration at steady state, WBC Goal trough: 15-20 mcg/mL Signup and view all the answers

What drug interactions should be considered when using vancomycin?

Nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs and radiographic contrast dye), ototoxic drugs (e.g., aminoglycosides, cisplatin, loop diuretics) Signup and view all the answers

Explain the mechanism of action of vancomycin and the type of bacteria it covers.

Vancomycin inhibits bacterial cell wall synthesis by binding to the D-alanyl - D-alanine cell wall precursor and blocking peptidoglycan polymerization. It covers Gram-positive bacteria, including Staphylococci (MRSA), Streptococci, Enterococci (not VRE) and C. difficile. Signup and view all the answers

What are the dosing recommendations for vancomycin in systemic infections and C. difficile infections?

For systemic infections (IV only), the dosing recommendation is IV: 15-20 mg/kg Q8-12H based on total body weight. For C. difficile infections (PO only), the recommendation is PO: 125-500 mg QID x 10 days. Signup and view all the answers

What safety considerations and warnings should be kept in mind when using vancomycin?

Vancomycin is associated with ototoxicity and nephrotoxicity. Caution should be exercised when using other nephrotoxic or ototoxic drugs or with prolonged high serum concentrations. Dose adjustment is required in renal impairment. The PO route is used only for C. difficile infections. Signup and view all the answers

Explain the side effects of Vancomycin.

Side effects of Vancomycin include abdominal pain, nausea (oral route), phlebitis (irritation to vein), myelosuppression (neutropenia/thrombocytopenia), drug fever, and severe skin reactions (SJS/TEN). Signup and view all the answers

Describe the recommended monitoring for Vancomycin therapy.

Monitoring for Vancomycin therapy should include renal function assessment and trough serum concentration at steady state, generally 30 minutes before the 4th or 5th dose. The goal trough concentration is 15-20 mcg/mL for conditions such as pneumonia, endocarditis, osteomyelitis, meningitis, and bacteremia. Signup and view all the answers

What are the drug interactions associated with Vancomycin?

Vancomycin can increase the risk of nephrotoxicity when used with other nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, and radiographic contrast dye). It can also elevate the risk of ototoxicity when used with other ototoxic drugs (e.g., aminoglycosides, cisplatin, loop diuretics). Signup and view all the answers

What are the potential infusion reactions associated with vancomycin, and how can they be prevented?

The potential infusion reactions include red man syndrome, which presents as maculopapular rash, hypotension, flushing, and chills from too rapid of an infusion rate. To prevent this, vancomycin should not be infused faster than 1 gram per hour. Signup and view all the answers

What are the side effects of vancomycin therapy?

The side effects of vancomycin therapy may include abdominal pain, nausea (with oral route), phlebitis (irritation to vein), myelosuppression (neutropenia/thrombocytopenia), drug fever, and severe skin reactions (SJS/TEN). Signup and view all the answers

Which drug interactions should be considered when using vancomycin?

When using vancomycin, the risk of nephrotoxicity is increased when used with other nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, and radiographic contrast dye). Vancomycin can also increase the risk of ototoxicity when used with other ototoxic drugs (e.g., aminoglycosides, cisplatin, loop diuretics). Signup and view all the answers

What is the mechanism of action of vancomycin and what types of bacteria does it cover?

Vancomycin inhibits bacterial cell wall synthesis by binding to the D-alanyl - D-alanine cell wall precursor and blocking peptidoglycan polymerization. It covers Gram-positive bacteria, including Staphylococci (MRSA), Streptococci, Enterococci (not VRE), and C. difficile. Signup and view all the answers

What are the dosing recommendations for vancomycin in systemic infections and C. difficile infections for a patient with CrCl 20-49 mL/min?

For systemic infections (IV only), the dosing is 15-20 mg/kg Q24H. For C. difficile infections (PO only), the dosing is 125-500 mg QID x 10 days (upper end used for severe, complicated disease). No dose adjustment is required in renal impairment. Signup and view all the answers

What are the safety considerations and warnings related to vancomycin use?

Vancomycin is associated with ototoxicity and nephrotoxicity. Caution should be exercised with the use of other nephrotoxic or ototoxic drugs or with prolonged high serum concentrations. Dose adjustment is required in renal impairment. The PO route is used only for C. difficile infections. Signup and view all the answers

Explain the potential infusion reaction/red man syndrome associated with vancomycin. What are the symptoms and how can it be prevented?

Infusion reaction/red man syndrome from vancomycin can present with maculopapular rash, hypotension, flushing, and chills when the drug is infused too rapidly, typically at rates faster than 1 gram per hour. This can be prevented by infusing vancomycin at a rate not exceeding 1 gram per hour. Signup and view all the answers

What are the potential side effects of vancomycin and how should they be monitored?

Potential side effects of vancomycin include abdominal pain, nausea (with oral route), phlebitis (irritation to vein), myelosuppression (neutropenia/thrombocytopenia), drug fever, and severe skin reactions (SJS/TEN). Vancomycin therapy should be monitored for renal function and trough serum concentration at steady state, with a goal trough of 15-20 mcg/mL for specific infections. Signup and view all the answers

What drug interactions should be considered when using vancomycin and how do they impact the risk of nephrotoxicity and ototoxicity?

Vancomycin use should be carefully monitored for potential interactions with other nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, and radiographic contrast dye) as they can increase the risk of nephrotoxicity. Additionally, vancomycin can potentiate the risk of ototoxicity when used with other ototoxic drugs (e.g., aminoglycosides, cisplatin, loop diuretics). Signup and view all the answers

What are the potential side effects and infusion reactions associated with vancomycin therapy?

The potential side effects of vancomycin therapy include abdominal pain, nausea, phlebitis, myelosuppression, drug fever, and severe skin reactions such as SJS/TEN. The infusion reactions may include red man syndrome, characterized by maculopapular rash, hypotension, flushing, and chills, which can be prevented by not infusing vancomycin faster than 1 gram per hour. Signup and view all the answers

What are the recommended monitoring parameters for vancomycin therapy?

The recommended monitoring parameters for vancomycin therapy include monitoring renal function and trough serum concentration at steady state, generally 30 minutes before the 4th or 5th dose. The goal trough concentration is 15-20 mcg/mL for indications such as pneumonia, endocarditis, osteomyelitis, meningitis, and bacteremia. Signup and view all the answers

Which drug interactions should be considered when using vancomycin?

When using vancomycin, it is important to consider the risk of nephrotoxicity when co-administered with other nephrotoxic drugs such as aminoglycosides, amphotericin B, cisplatin, polymyxins, cyclosporine, tacrolimus, loop diuretics, NSAIDs, and radiographic contrast dye. Vancomycin can also increase the risk of ototoxicity when used with other ototoxic drugs like aminoglycosides, cisplatin, and loop diuretics. Signup and view all the answers

List three lipoglycopeptide drugs and their approved indications.

Telavancin (Vibativ) Injection: Approved for complicated skin and soft-tissue infections (SSTI) and hospital-acquired and ventilator-associated pneumonia. Oritavancin (Orbactiv) Injection: Approved for SSTI. Dalbavancin (Dalvance) Injection: Approved for SSTI. Signup and view all the answers

What are the boxed warnings associated with lipoglycopeptides?

Fetal risk - obtain pregnancy test prior to starting therapy; nephrotoxicity; Increased mortality with pre-existing moderate-to-severe renal impairment (CrCI when compared to vancomycin in pneumonia trials. Signup and view all the answers

How do lipoglycopeptides inhibit bacterial cell wall synthesis?

They inhibit bacterial cell wall synthesis by binding to the D-alanyl- D-alanine portion of the cell wall, blocking polymerization and cross-linking of peptidoglycan, and disrupting bacterial membrane potential and changing cell permeability. Signup and view all the answers

What is the unique characteristic of lipoglycopeptides compared to vancomycin?

They have concentration-dependent antibacterial activity and have similar coverage to vancomycin, with the exception that they only come in IV form and cannot be used to treat C. difficile infections. Signup and view all the answers

What is the mechanism of action of lipoglycopeptides and how does it differ from vancomycin's mechanism of action?

Lipoglycopeptides inhibit bacterial cell wall synthesis by binding to the D-alanyl- D-alanine portion of the cell wall, blocking polymerization and cross-linking of peptidoglycan, and disrupting bacterial membrane potential and changing cell permeability due to the presence of a lipophilic side chain. This differs from vancomycin, which primarily inhibits cell wall synthesis by binding to the D-alanyl-D-alanine portion of the cell wall. Signup and view all the answers

What are the approved indications for Telavancin, Oritavancin, and Dalbavancin?

Telavancin (Vibativ) Injection is approved for complicated skin and soft-tissue infections (SSTI) and hospital-acquired and ventilator-associated pneumonia. Oritavancin (Orbactiv) Injection is approved for SSTI. Dalbavancin (Dalvance) Injection is approved for SSTI. Signup and view all the answers

What are the boxed warnings associated with lipoglycopeptides?

The boxed warnings for lipoglycopeptides include fetal risk (pregnancy test should be obtained prior to starting therapy), nephrotoxicity, and increased mortality with pre-existing moderate-to-severe renal impairment (CrCl) when compared to vancomycin in pneumonia trials. Signup and view all the answers

What is the concentration-dependent antibacterial activity of lipoglycopeptides and what is their similarity and difference to vancomycin in terms of form and treatment of C. difficile infections?

Lipoglycopeptides have concentration-dependent antibacterial activity and have similar coverage to vancomycin. However, they only come in IV form and cannot be used to treat C. difficile infections. Signup and view all the answers

Explain the mechanism of action of lipoglycopeptides and how it differs from vancomycin's mechanism of action.

Lipoglycopeptides inhibit bacterial cell wall synthesis by binding to the D-alanyl-D-alanine portion of the cell wall, blocking polymerization and cross-linking of peptidoglycan, and disrupting bacterial membrane potential and changing cell permeability due to the presence of a lipophilic side chain. This differs from vancomycin's mechanism of action which primarily involves binding to the D-alanyl-D-alanine portion of the cell wall and blocking peptidoglycan synthesis. Signup and view all the answers

What are the boxed warnings associated with lipoglycopeptides?

The boxed warnings associated with lipoglycopeptides include fetal risk (pregnancy test should be obtained prior to starting therapy), nephrotoxicity, and increased mortality with pre-existing moderate-to-severe renal impairment when compared to vancomycin in pneumonia trials. Signup and view all the answers

What are the lipoglycopeptide drugs and their approved indications?

The lipoglycopeptide drugs are Telavancin (Vibativ) Injection approved for complicated skin and soft-tissue infections (SSTI) and hospital-acquired and ventilator-associated pneumonia, Oritavancin (Orbactiv) Injection approved for SSTI, and Dalbavancin (Dalvance) Injection approved for SSTI. Signup and view all the answers

What are the concentration-dependent antibacterial activity and the similarity and difference of lipoglycopeptides to vancomycin?

Lipoglycopeptides have concentration-dependent antibacterial activity and have similar coverage to vancomycin, except that they only come in IV form and cannot be used to treat C. difficile infections. Signup and view all the answers

What precautions should be taken when coadministering oritavancin with drugs metabolized by specific enzymes?

Use caution when coadministered with drugs metabolized by CYP2C9 and CYP2C19, as oritavancin is a weak inhibitor of these enzymes. Signup and view all the answers

In which patients should telavancin be avoided?

Telavancin should be avoided in patients with congenital long QT syndrome, known QT prolongation, or uncompensated heart failure, as it can further prolong the QT interval. Signup and view all the answers

What caution should be exercised when using telavancin with other medications?

Use caution with other medications known to prolong the QT interval, as telavancin can exacerbate this effect, as mentioned in the Arrhythmias chapter. Signup and view all the answers

Which enzyme inhibition and induction effects should be considered when coadministering oritavancin with other drugs?

Oritavancin is a weak inhibitor of CYP2C9 and CYP2C19, and a weak inducer of CYP3A4 and CYP2D6. Signup and view all the answers

What caution should be exercised when using telavancin with other medications?

Telavancin should be avoided in patients with congenital long QT syndrome, known QT prolongation, or uncompensated heart failure. Caution should be used with other medications known to prolong the QT interval. Signup and view all the answers

What drug interactions should be considered when using telavancin and oritavancin?

Telavancin should be avoided in patients with congenital long QT syndrome, known QT prolongation, or uncompensated heart failure. Oritavancin is a weak inhibitor of CYP2C9 and CYP2C19, and a weak inducer of CYP3A4 and CYP2D6. Use caution when coadministered with drugs metabolized by these enzymes (including warfarin). Signup and view all the answers

Discuss the drug interactions and precautions that should be considered when using telavancin and oritavancin with other medications.

Telavancin should be avoided in patients with congenital long QT syndrome, known QT prolongation, or uncompensated heart failure. Caution should be exercised with other medications known to prolong the QT interval. Oritavancin is a weak inhibitor of CYP2C9 and CYP2C19, and a weak inducer of CYP3A4 and CYP2D6, therefore, caution is advised when coadministered with drugs metabolized by these enzymes, including warfarin. Signup and view all the answers

Explain the specific enzyme inhibition and induction effects of oritavancin and the caution needed when coadministering with other drugs.

Oritavancin is a weak inhibitor of CYP2C9 and CYP2C19, and a weak inducer of CYP3A4 and CYP2D6. When coadministered with drugs metabolized by these enzymes, caution is advised due to potential interactions affecting the metabolism of these drugs. Signup and view all the answers

What are the precautions and considerations to be taken when using telavancin in patients with specific medical conditions and in combination with other medications?

Telavancin should be avoided in patients with congenital long QT syndrome, known QT prolongation, or uncompensated heart failure. Additionally, caution is advised when using telavancin with other medications known to prolong the QT interval or with drugs metabolized by specific enzymes like CYP3A4, CYP2D6, CYP2C9, and CYP2C19. Signup and view all the answers

Explain the mechanism of action of Daptomycin and its antibacterial activity.

Daptomycin is a cyclic lipopeptide that binds to cell membrane components, causing rapid depolarization, inhibiting intracellular replication processes, including protein synthesis, and causing cell death. It has concentration-dependent antibacterial activity against most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococci (both species of VRE, E. faecium and E. faecalis). Signup and view all the answers

What are the approved indications for Daptomycin?

Daptomycin (Cubicin, Cubicin RF) is approved for complicated skin and soft-tissue infections (SSTI) and S.aureus (MRSA) bloodstream infections, including right-sided endocarditis. It should not be used to treat pneumonia as the drug is inactivated in the lungs by surfactant. Signup and view all the answers

What are the warnings and side effects associated with Daptomycin?

Warnings associated with Daptomycin include myopathy, rhabdomyolysis, and the potential to falsely increase PT/INR. The side effects include an increase in creatine phosphokinase (CPK) levels, which should be monitored weekly (more frequently if on a statin or with renal impairment). Signup and view all the answers

What drug interactions and precautions should be considered when using Daptomycin?

Daptomycin can have additive risk of muscle toxicity when used in conjunction with statins. It is important to monitor CPK levels, especially if the patient is on a statin or has renal impairment. Signup and view all the answers

Explain the mechanism of action of Daptomycin and its antibacterial activity.

Daptomycin is a cyclic lipopeptide that binds to cell membrane components, causing rapid depolarization, inhibiting intracellular replication processes, including protein synthesis, and causing cell death. It has concentration-dependent antibacterial activity against most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococci (both species of VRE, E. faecium and E. faecalis). Signup and view all the answers

What are the warnings and side effects associated with Daptomycin?

The warnings associated with Daptomycin include myopathy and rhabdomyolysis, and the potential to falsely increase PT/INR. The side effects include an increase in CPK levels. Signup and view all the answers

What are the drug interactions and precautions that should be considered when using Daptomycin?

Daptomycin can have additive risk of muscle toxicity when used in conjunction with statins. Monitoring of CPK levels is recommended, especially if the patient is on a statin or has renal impairment. Signup and view all the answers

What are the approved indications for Daptomycin?

Daptomycin (Cubicin, Cubicin RF) is approved for complicated skin and soft-tissue infections (SSTI) and S.aureus (MRSA) bloodstream infections, including right-sided endocarditis. It is not recommended for the treatment of pneumonia, as the drug is inactivated in the lungs by surfactant. Signup and view all the answers

Explain the concentration-dependent antibacterial activity of Daptomycin and its effectiveness against which types of bacteria?

Daptomycin has concentration-dependent antibacterial activity against most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococci (both species of VRE, E. faecium and E. faecalis). Signup and view all the answers

What are the warnings associated with Daptomycin, and what side effect should be monitored with its use?

Daptomycin warnings include myopathy and rhabdomyolysis, and it can falsely increase PT/INR. The side effect that should be monitored is the increase in CPK levels, with monitoring recommended weekly or more frequently if on a statin or with renal impairment. Signup and view all the answers

What are the compatibility considerations for Cubicin and Cubicin RF, and what drug interaction should be considered when using Daptomycin in conjunction with statins?

Cubicin is compatible with normal saline (NS) and lactated Ringer's (LR) without dextrose, while Cubicin RF is compatible with NS without dextrose, but must use only sterile or bacteriostatic water for injection to reconstitute the lyophilized powder. Daptomycin can have an additive risk of muscle toxicity when used with statins. Signup and view all the answers

What is the drug interaction and precaution concerning Daptomycin when used with other medications, and why should it not be used to treat pneumonia?

Daptomycin can have an additive risk of muscle toxicity when used with statins. It should not be used to treat pneumonia because the drug is inactivated in the lungs by surfactant. Signup and view all the answers

Which bacterial ribosomal subunit do linezolid and tedizolid bind to, and what is the result of this interaction?

They bind to the SOS subunit of the bacterial ribosome, inhibiting translation and protein synthesis. Signup and view all the answers

What bacterial strains are covered by oxazolidinones linezolid and tedizolid?

They have coverage similar to vancomycin, but also cover VRE (E. faecium and E. faecalis). Signup and view all the answers

What is the recommended dose and dosing frequency for linezolid (Zyvox)?

The recommended dose for linezolid is 600 mg Q12H, and no dose adjustment is required in renal impairment. The IV:PO ratio is 1:1. Signup and view all the answers

What are the contraindications and warnings associated with oxazolidinone drugs?

Do not use with or within 2 weeks of MAO inhibitors. Warnings include duration-related myelosuppression, peripheral and optic neuropathy, serotonin syndrome, hypoglycemia, seizures, lactic acidosis, and caution with insulin or other hypoglycemic drugs. Signup and view all the answers

What bacterial strains are covered by oxazolidinones linezolid and tedizolid?

They cover VRE (E. faecium and E. faecalis) as well as bacteria similar to vancomycin. Signup and view all the answers

What are the contraindications for oxazolidinone drugs?

Do not use with or within 2 weeks of MAO inhibitors. Signup and view all the answers

What are the warnings associated with oxazolidinone drugs?

Warnings include duration-related myelosuppression, peripheral and optic neuropathy when used for more than 28 days, serotonin syndrome, hypoglycemia, seizures, and lactic acidosis. Signup and view all the answers

What drug interactions should be considered when using linezolid and tedizolid?

They are reversible monoamine oxidase inhibitors, so it is important to avoid tyramine-containing foods and serotonergic drugs. Additionally, caution is advised when used with insulin or other hypoglycemic drugs. Signup and view all the answers

Explain the mechanism of action of oxazolidinone drugs linezolid and tedizolid.

They bind to the SOS subunit of the bacterial ribosome, inhibiting translation and protein synthesis. Signup and view all the answers

What are the contraindications and warnings associated with oxazolidinone drugs?

Contraindications include not using with or within 2 weeks of MAO inhibitors. Warnings include duration-related myelosuppression, peripheral and optic neuropathy when used > 28 days, serotonin syndrome, hypoglycemia, seizures, lactic acidosis, and caution with insulin or other hypoglycemic drugs. Signup and view all the answers

What are the side effects of oxazolidinone drugs?

Reduced platelets, reduced Hgb, reduced WBC, headache, nausea, diarrhea, and increased LFTs. Signup and view all the answers

What are the reversible monoamine oxidase inhibitor properties and related precautions of linezolid and tedizolid?

They are reversible monoamine oxidase inhibitors and should avoid tyramine-containing foods and serotonergic drugs. Linezolid can exacerbate hypoglycemic episodes, so caution should be used in patients receiving insulin or oral hypoglycemic drugs. Signup and view all the answers

What is the mechanism of action of Quinupristin/Dalfopristin?

Quinupristin/Dalfopristin is a streptogramin that binds to the 50S ribosomal subunit, inhibiting protein synthesis. Signup and view all the answers

What are the safety considerations and side effects associated with Quinupristin/Dalfopristin use?

The safety considerations and side effects of Quinupristin/Dalfopristin use include arthralgias/myalgias, infusion reactions, phlebitis, hyperbilirubinemia, CPK elevations, GI upset, and increased LFTs. Signup and view all the answers

How should Quinupristin/Dalfopristin be administered?

Quinupristin/Dalfopristin should be diluted in D5W only and administered via a central line, such as a peripherally inserted central catheter (PICC), to avoid phlebitis. Signup and view all the answers

What are the drug interactions of Quinupristin/Dalfopristin?

Quinupristin/Dalfopristin is a weak CYP3A4 inhibitor and can affect the levels of CCBs, cyclosporine, dofetilide, and other drugs. Signup and view all the answers

What is the mechanism of action of Quinupristin/Dalfopristin and which bacteria does it cover?

Quinupristin/Dalfopristin is a streptogramin that binds to the 50S ribosomal subunit, inhibiting protein synthesis. It covers most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococcus faecium (VRE, but not E. faecalis). Signup and view all the answers

What are the side effects and safety concerns associated with Quinupristin/Dalfopristin?

The side effects and safety concerns associated with Quinupristin/Dalfopristin include arthralgias/myalgias, infusion reactions, phlebitis, hyperbilirubinemia, CPK elevations, gastrointestinal upset, and increases in LFTs. It is also not well-tolerated and is typically limited to vancomycin-resistant Enterococcus faecium infections. Signup and view all the answers

How should Quinupristin/Dalfopristin be administered, and what are the drug interactions to consider?

Quinupristin/Dalfopristin should be diluted in D5W only and administered via a central line to avoid phlebitis. It is a weak CYP3A4 inhibitor and can affect the levels of CCBs, cyclosporine, dofetilide, and other drugs. Signup and view all the answers

What are the approved indications for Quinupristin/Dalfopristin?

Quinupristin/Dalfopristin is approved for complicated skin and soft-tissue infections, particularly in cases of vancomycin-resistant Enterococcus faecium infections. Signup and view all the answers

Explain the mechanism of action of Quinupristin/Dalfopristin and which bacteria does it cover?

Quinupristin/Dalfopristin is a streptogramin that binds to the 50S ribosomal subunit inhibiting protein synthesis. It covers most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococcus faecium (VRE, but not E. faecalis). Signup and view all the answers

What are the safety considerations and warnings related to Quinupristin/Dalfopristin use?

Quinupristin/Dalfopristin has safety considerations such as arthralgias/myalgias, infusion reactions, phlebitis, hyperbilirubinemia, CPK elevations, gastrointestinal upset, and increased liver function tests. It should be diluted in D5W only and administered via a central line to avoid phlebitis. Signup and view all the answers

What are the drug interactions associated with Quinupristin/Dalfopristin?

Quinupristin/Dalfopristin is a weak CYP3A4 inhibitor and can affect the levels of drugs such as calcium channel blockers, cyclosporine, and dofetilide. Signup and view all the answers

What are the approved indications for Quinupristin/Dalfopristin use?

Quinupristin/Dalfopristin is approved for complicated skin and soft-tissue infections, with limited use for vancomycin-resistant Enterococcus faecium infections. Signup and view all the answers

Explain the mechanism of action of Quinupristin/Dalfopristin and its coverage of bacterial strains.

Quinupristin/Dalfopristin is a streptogramin that binds to the 50S ribosomal subunit, inhibiting protein synthesis. It covers most Gram-positive bacteria, including Staphylococci (MRSA) and Enterococcus faecium (VRE, but not E. faecalis). Signup and view all the answers

What are the safety considerations and warnings related to Quinupristin/Dalfopristin use?

Quinupristin/Dalfopristin is associated with side effects such as arthralgias/myalgias, infusion reactions, phlebitis, hyperbilirubinemia, CPK elevations, GI upset, and increased LFTs. It should be diluted in D5W only and administered via a central line to avoid phlebitis. Signup and view all the answers

What drug interactions should be considered when using Quinupristin/Dalfopristin?

Quinupristin/Dalfopristin is a weak CYP3A4 inhibitor and can affect the levels of drugs such as calcium channel blockers, cyclosporine, dofetilide, and others. Signup and view all the answers

In what clinical scenarios is the use of Quinupristin/Dalfopristin typically limited?

The use of Quinupristin/Dalfopristin is typically limited to vancomycin-resistant Enterococcus faecium infections. Signup and view all the answers

What is the mechanism of action of Tigecycline and what types of bacteria does it cover?

Tigecycline is a glycylcycline that binds to the 30S ribosomal subunit, inhibiting protein synthesis. It has a broad-spectrum of activity against Gram-positive bacteria, including Staphylococci (MRSA) and Enterococci (VRE), Gram-negative bacteria, anaerobes, and atypical organisms. It has no activity against the '3 P's': Pseudomonas, Proteus, Providencia species. Signup and view all the answers

What are the safety concerns and side effects associated with Tigecycline use?

Tigecycline has a boxed warning for increased risk of death and should only be used when alternative treatments are not suitable. It is associated with hepatotoxicity, pancreatitis, photosensitivity, lower cure rates in ventilator-associated pneumonia, and teeth discoloration in children under 8 years old. Common side effects include nausea, vomiting, diarrhea, headache, dizziness, elevated liver function tests, and rash/severe skin reactions. Signup and view all the answers

What are the limitations and precautions for using Tigecycline?

Tigecycline is not recommended for bloodstream infections as it does not achieve adequate concentrations in the blood. Reconstituted solution should be yellow-orange, and if not, it should be discarded. It should be used with caution in patients taking warfarin, as it can affect the International Normalized Ratio (INR). Signup and view all the answers

What are the approved indications for Tigecycline?

Tigecycline is approved for complicated skin and soft-tissue infections, intra-abdominal infections, and community-acquired pneumonia, with limited use due to safety concerns and boxed warning. Signup and view all the answers

Explain the mechanism of action of Tigecycline and its spectrum of activity?

Tigecycline binds to the 30S ribosomal subunit inhibiting protein synthesis and has a broad-spectrum of activity against Gram-positive bacteria including MRSA and VRE, Gram-negative bacteria, anaerobes, and atypical organisms. Signup and view all the answers

What are the boxed warnings and potential side effects of Tigecycline?

The boxed warning for Tigecycline includes an increased risk of death and should only be used when alternative treatments are not suitable. Potential side effects include hepatotoxicity, pancreatitis, photosensitivity, teeth discoloration in children under 8 years old, lower cure rates in ventilator-associated pneumonia, nausea, vomiting, diarrhea, headache, dizziness, elevated liver function tests, and rash/severe skin reactions (SJS). Signup and view all the answers

What are the limitations on the use of Tigecycline and what drug interactions should be considered?

Tigecycline is approved for complicated skin and soft-tissue infections, intra-abdominal infections, and community-acquired pneumonia, with the limitation of not being suitable for bloodstream infections due to inadequate concentrations in the blood. Tigecycline can increase the INR in patients taking warfarin. Signup and view all the answers

What are the unique characteristics of Tigecycline in terms of its reconstituted solution and distribution in the body?

The reconstituted solution of Tigecycline should be yellow-orange, and it should be discarded if not this color. Tigecycline does not achieve adequate concentrations in the blood since it is lipophilic, leading to quick distribution out of the blood into tissues. Signup and view all the answers

Explain the mechanism of action of Tigecycline and its spectrum of activity?

Tigecycline is a glycylcycline that binds to the 30S ribosomal subunit, inhibiting protein synthesis. It has a broad-spectrum of activity against Gram-positive bacteria, including Staphylococci (MRSA) and Enterococci (VRE), Gram-negative bacteria, anaerobes, and atypical organisms. However, it has no activity against the '3 P's': Pseudomonas, Proteus, Providencia species. Signup and view all the answers

What are the boxed warning, warnings, and side effects associated with Tigecycline use?

Boxed Warning: Increased risk of death, use only when alternative treatments are not suitable. Warnings: Hepatotoxicity, pancreatitis, photosensitivity, teeth discoloration in children < 8 years old (avoid use), lower cure rates in ventilator-associated pneumonia. Side Effects: N/V/D, headache, dizziness, elevated liver function tests, rash/severe skin reactions (SJS). Signup and view all the answers

What are the limitations and special considerations for Tigecycline use?

Tigecycline is approved for complicated skin and soft-tissue infections, intra-abdominal infections, and community-acquired pneumonia. However, it should not be used for bloodstream infections as it does not achieve adequate concentrations in the blood due to its lipophilic nature. Signup and view all the answers

What are the drug interactions and specific caution associated with Tigecycline use?

Tigecycline can affect the INR in patients taking warfarin. Additionally, the reconstituted solution should be yellow-orange; it should be discarded if not this color. Furthermore, Tigecycline should not be used in children below 8 years of age to avoid teeth discoloration. Signup and view all the answers

ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

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Questions and Answers

What is the mechanism of action of vancomycin?

Which type of bacteria does vancomycin cover?

What is the dosing recommendation for systemic infections?

What are the side effects of vancomycin?

What are the monitoring parameters for vancomycin therapy?

What drug interactions should be considered when using vancomycin?

Explain the mechanism of action of vancomycin and the type of bacteria it covers.

What are the dosing recommendations for vancomycin in systemic infections and C. difficile infections?

What safety considerations and warnings should be kept in mind when using vancomycin?

Explain the side effects of Vancomycin.

Describe the recommended monitoring for Vancomycin therapy.

What are the drug interactions associated with Vancomycin?

What are the potential infusion reactions associated with vancomycin, and how can they be prevented?

What are the side effects of vancomycin therapy?

Which drug interactions should be considered when using vancomycin?

What is the mechanism of action of vancomycin and what types of bacteria does it cover?

What are the dosing recommendations for vancomycin in systemic infections and C. difficile infections for a patient with CrCl 20-49 mL/min?

What are the safety considerations and warnings related to vancomycin use?

Explain the potential infusion reaction/red man syndrome associated with vancomycin. What are the symptoms and how can it be prevented?

What are the potential side effects of vancomycin and how should they be monitored?

What drug interactions should be considered when using vancomycin and how do they impact the risk of nephrotoxicity and ototoxicity?

What are the potential side effects and infusion reactions associated with vancomycin therapy?

What are the recommended monitoring parameters for vancomycin therapy?

Which drug interactions should be considered when using vancomycin?

List three lipoglycopeptide drugs and their approved indications.

What are the boxed warnings associated with lipoglycopeptides?

How do lipoglycopeptides inhibit bacterial cell wall synthesis?

What is the unique characteristic of lipoglycopeptides compared to vancomycin?

What is the mechanism of action of lipoglycopeptides and how does it differ from vancomycin's mechanism of action?

What are the approved indications for Telavancin, Oritavancin, and Dalbavancin?

What are the boxed warnings associated with lipoglycopeptides?

What is the concentration-dependent antibacterial activity of lipoglycopeptides and what is their similarity and difference to vancomycin in terms of form and treatment of C. difficile infections?

Explain the mechanism of action of lipoglycopeptides and how it differs from vancomycin's mechanism of action.

What are the boxed warnings associated with lipoglycopeptides?

What are the lipoglycopeptide drugs and their approved indications?

What are the concentration-dependent antibacterial activity and the similarity and difference of lipoglycopeptides to vancomycin?

What precautions should be taken when coadministering oritavancin with drugs metabolized by specific enzymes?

In which patients should telavancin be avoided?

What caution should be exercised when using telavancin with other medications?

Which enzyme inhibition and induction effects should be considered when coadministering oritavancin with other drugs?

What caution should be exercised when using telavancin with other medications?

What drug interactions should be considered when using telavancin and oritavancin?

Discuss the drug interactions and precautions that should be considered when using telavancin and oritavancin with other medications.

Explain the specific enzyme inhibition and induction effects of oritavancin and the caution needed when coadministering with other drugs.

What are the precautions and considerations to be taken when using telavancin in patients with specific medical conditions and in combination with other medications?

Explain the mechanism of action of Daptomycin and its antibacterial activity.

What are the approved indications for Daptomycin?

What are the warnings and side effects associated with Daptomycin?

What drug interactions and precautions should be considered when using Daptomycin?

Explain the mechanism of action of Daptomycin and its antibacterial activity.

What are the warnings and side effects associated with Daptomycin?

What are the drug interactions and precautions that should be considered when using Daptomycin?

What are the approved indications for Daptomycin?

Explain the concentration-dependent antibacterial activity of Daptomycin and its effectiveness against which types of bacteria?

What are the warnings associated with Daptomycin, and what side effect should be monitored with its use?

What are the compatibility considerations for Cubicin and Cubicin RF, and what drug interaction should be considered when using Daptomycin in conjunction with statins?

What is the drug interaction and precaution concerning Daptomycin when used with other medications, and why should it not be used to treat pneumonia?

Which bacterial ribosomal subunit do linezolid and tedizolid bind to, and what is the result of this interaction?

What bacterial strains are covered by oxazolidinones linezolid and tedizolid?

What is the recommended dose and dosing frequency for linezolid (Zyvox)?

What are the contraindications and warnings associated with oxazolidinone drugs?

What bacterial strains are covered by oxazolidinones linezolid and tedizolid?

What are the contraindications for oxazolidinone drugs?

What are the warnings associated with oxazolidinone drugs?

What drug interactions should be considered when using linezolid and tedizolid?

Explain the mechanism of action of oxazolidinone drugs linezolid and tedizolid.

What are the contraindications and warnings associated with oxazolidinone drugs?

What are the side effects of oxazolidinone drugs?

What are the reversible monoamine oxidase inhibitor properties and related precautions of linezolid and tedizolid?

What is the mechanism of action of Quinupristin/Dalfopristin?

What are the safety considerations and side effects associated with Quinupristin/Dalfopristin use?

How should Quinupristin/Dalfopristin be administered?

What are the drug interactions of Quinupristin/Dalfopristin?

What is the mechanism of action of Quinupristin/Dalfopristin and which bacteria does it cover?

What are the side effects and safety concerns associated with Quinupristin/Dalfopristin?

How should Quinupristin/Dalfopristin be administered, and what are the drug interactions to consider?